(a) "Actuarial certification" means a written statement by a member of theAmericanacademy of actuaries or other individual acceptable to the commissioner that asmall employercarrier is in compliance with the provisions of K.S.A. 40-2209h and amendmentsthereto, based uponthe person's examination, including a review of the appropriate records and ofthe actuarialassumptions and methods used by the small employer carrier in establishingpremium rates forapplicable health benefit plans.
(b) "Approved service area" means a geographical area, as approved by thecommissioner to transact insurance in this state, within which the carrier isauthorized to provide coverage.
(c) "Base premium rate" means, for each class of business as to a ratingperiod, the lowest premium rate charged or that could have been charged underthe rating system for that class of business, by the small employer carrier tosmall employers with similar case characteristics for health benefit plans withthe same or similar coverage.
(d) "Carrier" or "small employer carrier" means any insurance company,nonprofit medical and hospital service corporation, nonprofit optometric,dental, and pharmacy service corporations, municipal group-funded pool,fraternal benefit society or health maintenance organization, as these termsare defined by the Kansas Statutes Annotated, that offers health benefit planscovering eligible employees of one or more small employers in this state.
(e) "Case characteristics" means, with respect to a small employer, thegeographic area inwhich the employees reside; the age and sex of the individual employees andtheir dependents; the appropriate industry classification as determined by thecarrier, and the number of employees and dependents and such other objectivecriteria as may be approved family composition by the commissioner. "Casecharacteristics" shall not include claim experience, health status and durationof coverage since issue.
(f) "Class of business" means all or a separate grouping of small employersestablished pursuant to K.S.A. 40-2209g and amendments thereto.
(g) "Commissioner" means the commissioner of insurance.
(h) "Department" means the insurance department.
(i) "Dependent" means the spouse or child of an eligible employee, subject toapplicable terms of the health benefits plan covering such employee and thedependent eligibility standards established by the board.
(j) "Eligible employee" means an employee who works on a full-time basis,with a normal work week of 30 or more hours, and includes a sole proprietor, apartner of a partnership or an independent contractor, provided such soleproprietor, partner or independent contractor is included as an employee undera health benefit plan of a small employer but does not include an employee whoworks on a part-time, temporary or substitute basis.
(k) "Financially impaired" means a member which, after the effective date ofthis act, is not insolvent but is:
(1) Deemed by the commissioner to be in a hazardous financial conditionpursuant to K.S.A. 40-222d and amendments thereto; or
(2) placed under an order of rehabilitation or conservation by a court ofcompetent jurisdiction.
(l) "Health benefit plan" means any hospital or medical expense policy,health, hospital ormedical service corporation contract, and a plan provided by a municipalgroup-funded pool, or a health maintenance organization contract offered by anemployer or any certificate issued under any such policies, contracts or plans.Health benefit plan also includes a cafeteria plan authorized by 26 U.S.C.Section 125 which offers the option of receiving health insurance coveragethrough a high deductible health plan and the establishment of a health savingsaccount. In order for an eligible individual to obtain a high deductible healthplan through the cafeteria plan, such individual shall present evidence to theemployer that such individual has established a health savings account incompliance with 26 U.S.C. Section 223, and any amendments and regulations."Health benefit plan" does not include policies or certificates covering onlyaccident, credit, dental, disability income, long-term care, hospitalindemnity, medicare supplement, specified disease, vision care, coverage issuedas a supplement to liability insurance, insurance arising out of a workerscompensation or similar law, automobile medical-payment insurance, or insuranceunder which benefits are payable with or without regard to fault and which isstatutorily required to be contained in any liabilityinsurance policy or equivalent self-insurance.
(m) "Health savings account" shall have the same meaning ascribed to it as insubsection (d) of 26 U.S.C. Section 223.
(n) "High deductible health plan" shall mean a policy or contract of healthinsurance or health care plan that meets the criteria established in subsection(c) of 26 U.S.C. Section 223 and any regulations promulgated thereunder.
(o) "Index rate" means, for each class of business as to a rating period forsmall employers with similar case characteristics, the arithmetic average ofthe applicable base premium rate and the corresponding highest premium rate.
(p) "Initial enrollment period" means the period of time specified in thehealth benefit plan during which an individual is first eligible to enroll in asmall employer health benefit plan. Such period shall be no less favorable thana period beginning on the employee's or member's dateof initial eligibility and ending 31 days thereafter.
(q) "Late enrollee" means an eligible employee or dependent who requestsenrollment in a small employer's health benefit plan following the initialenrollment period provided under the terms of the first plan for which suchemployee or dependent was eligible through such small employer, however aneligible employee or dependent shall not be considered a late enrollee if:
(1) The individual:
(A) Was covered under another employer-provided health benefit plan or wascovered under section 607(1) of the employee retirement income security act of1974 (ERISA) at the time the individual was eligible to enroll;
(B) states in writing, at the time of the initial eligibility, that coverageunder another employer health benefit plan was the reason for decliningenrollment but only if the group policyholder or the accident and sicknessissuer required such a written statement and provided the individual withnotice of the requirement for a written statement and the consequences of suchwritten statement;
(C) has lost coverage under another employer health benefit plan or undersection 607(1) of the employee retirement income security act of 1974 (ERISA)as a result of the termination of employment, reduction in the number of hoursof employment, termination of employer contributions toward such coverage, thetermination of the other plan's coverage, death of a spouse, or divorce orlegal separation; and
(D) requests enrollment within 63 days after the termination of coverageunder another employer health benefit plan; or
(2) the individual is employed by an employer who offers multiple healthbenefit plans and the individual elects a different health benefit plan duringan open enrollment period; or
(3) a court has ordered coverage to be provided for a spouse or minor childunder a covered employee's plan.
(r) "New business premium rate" means, for each class of business as to arating period, the lowest premium rate charged or offered, or which could havebeen charged or offered, by the small employer carrier to small employers withsimilar case characteristics for newly issued health benefit plans with thesame or similar coverage.
(s) "Preexisting conditions exclusion" means a policy provision whichexcludes or limits coverage for charges or expenses incurred during a specifiedperiod not to exceed 90 days following the insured's effective date ofenrollment as to a condition, whether physical or mental, regardless of thecause of the condition for which medical advice, diagnosis, care or treatmentwas recommended or received in the six months immediately preceding theeffective date of enrollment.
(t) "Premium" means moneys paid by a small employer or eligible employees orboth as a condition of receiving coverage from a small employer carrier,including any fees or othercontributions associated with the health benefit plan.
(u) "Rating period" means the calendar period for which premium ratesestablished by a small employer carrier are assumed to be in effect but anyperiod of less than one year shall be considered as a full year.
(v) "Waiting period" means a period of time after full-time employment beginsbefore an employee is first eligible to enroll in any applicable health benefitplan offered by the small employer.
(w) "Small employer" means any person, firm, corporation, partnership orassociation eligible for group sickness and accident insurance pursuant tosubsection (a) of K.S.A. 40-2209 and amendments thereto actively engaged inbusiness whose total employed work force consisted of, on at least 50% of itsworking days during the preceding year, of at least two and no more than 50eligible employees, the majority of whom were employed within the state. Indetermining the number of eligible employees, companies which are affiliatedcompanies or which are eligible to file a combined tax return for purposes ofstate taxation, shall be considered one employer. Except asotherwise specifically provided, provisions of this act which apply to a smallemployer which has a health benefit plan shall continue to apply until the plananniversary following the date the employer no longer meets the requirements ofthis definition.
(x) "Affiliate" or "affiliated" means an entity or person who directly orindirectly through one or more intermediaries, controls or is controlled by, oris under common control with, a specified entity or person.
(a) "Actuarial certification" means a written statement by a member of theAmericanacademy of actuaries or other individual acceptable to the commissioner that asmall employercarrier is in compliance with the provisions of K.S.A. 40-2209h and amendmentsthereto, based uponthe person's examination, including a review of the appropriate records and ofthe actuarialassumptions and methods used by the small employer carrier in establishingpremium rates forapplicable health benefit plans.
(b) "Approved service area" means a geographical area, as approved by thecommissioner to transact insurance in this state, within which the carrier isauthorized to provide coverage.
(c) "Base premium rate" means, for each class of business as to a ratingperiod, the lowest premium rate charged or that could have been charged underthe rating system for that class of business, by the small employer carrier tosmall employers with similar case characteristics for health benefit plans withthe same or similar coverage.
(d) "Carrier" or "small employer carrier" means any insurance company,nonprofit medical and hospital service corporation, nonprofit optometric,dental, and pharmacy service corporations, municipal group-funded pool,fraternal benefit society or health maintenance organization, as these termsare defined by the Kansas Statutes Annotated, that offers health benefit planscovering eligible employees of one or more small employers in this state.
(e) "Case characteristics" means, with respect to a small employer, thegeographic area inwhich the employees reside; the age and sex of the individual employees andtheir dependents; the appropriate industry classification as determined by thecarrier, and the number of employees and dependents and such other objectivecriteria as may be approved family composition by the commissioner. "Casecharacteristics" shall not include claim experience, health status and durationof coverage since issue.
(f) "Class of business" means all or a separate grouping of small employersestablished pursuant to K.S.A. 40-2209g and amendments thereto.
(g) "Commissioner" means the commissioner of insurance.
(h) "Department" means the insurance department.
(i) "Dependent" means the spouse or child of an eligible employee, subject toapplicable terms of the health benefits plan covering such employee and thedependent eligibility standards established by the board.
(j) "Eligible employee" means an employee who works on a full-time basis,with a normal work week of 30 or more hours, and includes a sole proprietor, apartner of a partnership or an independent contractor, provided such soleproprietor, partner or independent contractor is included as an employee undera health benefit plan of a small employer but does not include an employee whoworks on a part-time, temporary or substitute basis.
(k) "Financially impaired" means a member which, after the effective date ofthis act, is not insolvent but is:
(1) Deemed by the commissioner to be in a hazardous financial conditionpursuant to K.S.A. 40-222d and amendments thereto; or
(2) placed under an order of rehabilitation or conservation by a court ofcompetent jurisdiction.
(l) "Health benefit plan" means any hospital or medical expense policy,health, hospital ormedical service corporation contract, and a plan provided by a municipalgroup-funded pool, or a health maintenance organization contract offered by anemployer or any certificate issued under any such policies, contracts or plans.Health benefit plan also includes a cafeteria plan authorized by 26 U.S.C.Section 125 which offers the option of receiving health insurance coveragethrough a high deductible health plan and the establishment of a health savingsaccount. In order for an eligible individual to obtain a high deductible healthplan through the cafeteria plan, such individual shall present evidence to theemployer that such individual has established a health savings account incompliance with 26 U.S.C. Section 223, and any amendments and regulations."Health benefit plan" does not include policies or certificates covering onlyaccident, credit, dental, disability income, long-term care, hospitalindemnity, medicare supplement, specified disease, vision care, coverage issuedas a supplement to liability insurance, insurance arising out of a workerscompensation or similar law, automobile medical-payment insurance, or insuranceunder which benefits are payable with or without regard to fault and which isstatutorily required to be contained in any liabilityinsurance policy or equivalent self-insurance.
(m) "Health savings account" shall have the same meaning ascribed to it as insubsection (d) of 26 U.S.C. Section 223.
(n) "High deductible health plan" shall mean a policy or contract of healthinsurance or health care plan that meets the criteria established in subsection(c) of 26 U.S.C. Section 223 and any regulations promulgated thereunder.
(o) "Index rate" means, for each class of business as to a rating period forsmall employers with similar case characteristics, the arithmetic average ofthe applicable base premium rate and the corresponding highest premium rate.
(p) "Initial enrollment period" means the period of time specified in thehealth benefit plan during which an individual is first eligible to enroll in asmall employer health benefit plan. Such period shall be no less favorable thana period beginning on the employee's or member's dateof initial eligibility and ending 31 days thereafter.
(q) "Late enrollee" means an eligible employee or dependent who requestsenrollment in a small employer's health benefit plan following the initialenrollment period provided under the terms of the first plan for which suchemployee or dependent was eligible through such small employer, however aneligible employee or dependent shall not be considered a late enrollee if:
(1) The individual:
(A) Was covered under another employer-provided health benefit plan or wascovered under section 607(1) of the employee retirement income security act of1974 (ERISA) at the time the individual was eligible to enroll;
(B) states in writing, at the time of the initial eligibility, that coverageunder another employer health benefit plan was the reason for decliningenrollment but only if the group policyholder or the accident and sicknessissuer required such a written statement and provided the individual withnotice of the requirement for a written statement and the consequences of suchwritten statement;
(C) has lost coverage under another employer health benefit plan or undersection 607(1) of the employee retirement income security act of 1974 (ERISA)as a result of the termination of employment, reduction in the number of hoursof employment, termination of employer contributions toward such coverage, thetermination of the other plan's coverage, death of a spouse, or divorce orlegal separation; and
(D) requests enrollment within 63 days after the termination of coverageunder another employer health benefit plan; or
(2) the individual is employed by an employer who offers multiple healthbenefit plans and the individual elects a different health benefit plan duringan open enrollment period; or
(3) a court has ordered coverage to be provided for a spouse or minor childunder a covered employee's plan.
(r) "New business premium rate" means, for each class of business as to arating period, the lowest premium rate charged or offered, or which could havebeen charged or offered, by the small employer carrier to small employers withsimilar case characteristics for newly issued health benefit plans with thesame or similar coverage.
(s) "Preexisting conditions exclusion" means a policy provision whichexcludes or limits coverage for charges or expenses incurred during a specifiedperiod not to exceed 90 days following the insured's effective date ofenrollment as to a condition, whether physical or mental, regardless of thecause of the condition for which medical advice, diagnosis, care or treatmentwas recommended or received in the six months immediately preceding theeffective date of enrollment.
(t) "Premium" means moneys paid by a small employer or eligible employees orboth as a condition of receiving coverage from a small employer carrier,including any fees or othercontributions associated with the health benefit plan.
(u) "Rating period" means the calendar period for which premium ratesestablished by a small employer carrier are assumed to be in effect but anyperiod of less than one year shall be considered as a full year.
(v) "Waiting period" means a period of time after full-time employment beginsbefore an employee is first eligible to enroll in any applicable health benefitplan offered by the small employer.
(w) "Small employer" means any person, firm, corporation, partnership orassociation eligible for group sickness and accident insurance pursuant tosubsection (a) of K.S.A. 40-2209 and amendments thereto actively engaged inbusiness whose total employed work force consisted of, on at least 50% of itsworking days during the preceding year, of at least two and no more than 50eligible employees, the majority of whom were employed within the state. Indetermining the number of eligible employees, companies which are affiliatedcompanies or which are eligible to file a combined tax return for purposes ofstate taxation, shall be considered one employer. Except asotherwise specifically provided, provisions of this act which apply to a smallemployer which has a health benefit plan shall continue to apply until the plananniversary following the date the employer no longer meets the requirements ofthis definition.
(x) "Affiliate" or "affiliated" means an entity or person who directly orindirectly through one or more intermediaries, controls or is controlled by, oris under common control with, a specified entity or person.
(a) "Actuarial certification" means a written statement by a member of theAmericanacademy of actuaries or other individual acceptable to the commissioner that asmall employercarrier is in compliance with the provisions of K.S.A. 40-2209h and amendmentsthereto, based uponthe person's examination, including a review of the appropriate records and ofthe actuarialassumptions and methods used by the small employer carrier in establishingpremium rates forapplicable health benefit plans.
(b) "Approved service area" means a geographical area, as approved by thecommissioner to transact insurance in this state, within which the carrier isauthorized to provide coverage.
(c) "Base premium rate" means, for each class of business as to a ratingperiod, the lowest premium rate charged or that could have been charged underthe rating system for that class of business, by the small employer carrier tosmall employers with similar case characteristics for health benefit plans withthe same or similar coverage.
(d) "Carrier" or "small employer carrier" means any insurance company,nonprofit medical and hospital service corporation, nonprofit optometric,dental, and pharmacy service corporations, municipal group-funded pool,fraternal benefit society or health maintenance organization, as these termsare defined by the Kansas Statutes Annotated, that offers health benefit planscovering eligible employees of one or more small employers in this state.
(e) "Case characteristics" means, with respect to a small employer, thegeographic area inwhich the employees reside; the age and sex of the individual employees andtheir dependents; the appropriate industry classification as determined by thecarrier, and the number of employees and dependents and such other objectivecriteria as may be approved family composition by the commissioner. "Casecharacteristics" shall not include claim experience, health status and durationof coverage since issue.
(f) "Class of business" means all or a separate grouping of small employersestablished pursuant to K.S.A. 40-2209g and amendments thereto.
(g) "Commissioner" means the commissioner of insurance.
(h) "Department" means the insurance department.
(i) "Dependent" means the spouse or child of an eligible employee, subject toapplicable terms of the health benefits plan covering such employee and thedependent eligibility standards established by the board.
(j) "Eligible employee" means an employee who works on a full-time basis,with a normal work week of 30 or more hours, and includes a sole proprietor, apartner of a partnership or an independent contractor, provided such soleproprietor, partner or independent contractor is included as an employee undera health benefit plan of a small employer but does not include an employee whoworks on a part-time, temporary or substitute basis.
(k) "Financially impaired" means a member which, after the effective date ofthis act, is not insolvent but is:
(1) Deemed by the commissioner to be in a hazardous financial conditionpursuant to K.S.A. 40-222d and amendments thereto; or
(2) placed under an order of rehabilitation or conservation by a court ofcompetent jurisdiction.
(l) "Health benefit plan" means any hospital or medical expense policy,health, hospital ormedical service corporation contract, and a plan provided by a municipalgroup-funded pool, or a health maintenance organization contract offered by anemployer or any certificate issued under any such policies, contracts or plans.Health benefit plan also includes a cafeteria plan authorized by 26 U.S.C.Section 125 which offers the option of receiving health insurance coveragethrough a high deductible health plan and the establishment of a health savingsaccount. In order for an eligible individual to obtain a high deductible healthplan through the cafeteria plan, such individual shall present evidence to theemployer that such individual has established a health savings account incompliance with 26 U.S.C. Section 223, and any amendments and regulations."Health benefit plan" does not include policies or certificates covering onlyaccident, credit, dental, disability income, long-term care, hospitalindemnity, medicare supplement, specified disease, vision care, coverage issuedas a supplement to liability insurance, insurance arising out of a workerscompensation or similar law, automobile medical-payment insurance, or insuranceunder which benefits are payable with or without regard to fault and which isstatutorily required to be contained in any liabilityinsurance policy or equivalent self-insurance.
(m) "Health savings account" shall have the same meaning ascribed to it as insubsection (d) of 26 U.S.C. Section 223.
(n) "High deductible health plan" shall mean a policy or contract of healthinsurance or health care plan that meets the criteria established in subsection(c) of 26 U.S.C. Section 223 and any regulations promulgated thereunder.
(o) "Index rate" means, for each class of business as to a rating period forsmall employers with similar case characteristics, the arithmetic average ofthe applicable base premium rate and the corresponding highest premium rate.
(p) "Initial enrollment period" means the period of time specified in thehealth benefit plan during which an individual is first eligible to enroll in asmall employer health benefit plan. Such period shall be no less favorable thana period beginning on the employee's or member's dateof initial eligibility and ending 31 days thereafter.
(q) "Late enrollee" means an eligible employee or dependent who requestsenrollment in a small employer's health benefit plan following the initialenrollment period provided under the terms of the first plan for which suchemployee or dependent was eligible through such small employer, however aneligible employee or dependent shall not be considered a late enrollee if:
(1) The individual:
(A) Was covered under another employer-provided health benefit plan or wascovered under section 607(1) of the employee retirement income security act of1974 (ERISA) at the time the individual was eligible to enroll;
(B) states in writing, at the time of the initial eligibility, that coverageunder another employer health benefit plan was the reason for decliningenrollment but only if the group policyholder or the accident and sicknessissuer required such a written statement and provided the individual withnotice of the requirement for a written statement and the consequences of suchwritten statement;
(C) has lost coverage under another employer health benefit plan or undersection 607(1) of the employee retirement income security act of 1974 (ERISA)as a result of the termination of employment, reduction in the number of hoursof employment, termination of employer contributions toward such coverage, thetermination of the other plan's coverage, death of a spouse, or divorce orlegal separation; and
(D) requests enrollment within 63 days after the termination of coverageunder another employer health benefit plan; or
(2) the individual is employed by an employer who offers multiple healthbenefit plans and the individual elects a different health benefit plan duringan open enrollment period; or
(3) a court has ordered coverage to be provided for a spouse or minor childunder a covered employee's plan.
(r) "New business premium rate" means, for each class of business as to arating period, the lowest premium rate charged or offered, or which could havebeen charged or offered, by the small employer carrier to small employers withsimilar case characteristics for newly issued health benefit plans with thesame or similar coverage.
(s) "Preexisting conditions exclusion" means a policy provision whichexcludes or limits coverage for charges or expenses incurred during a specifiedperiod not to exceed 90 days following the insured's effective date ofenrollment as to a condition, whether physical or mental, regardless of thecause of the condition for which medical advice, diagnosis, care or treatmentwas recommended or received in the six months immediately preceding theeffective date of enrollment.
(t) "Premium" means moneys paid by a small employer or eligible employees orboth as a condition of receiving coverage from a small employer carrier,including any fees or othercontributions associated with the health benefit plan.
(u) "Rating period" means the calendar period for which premium ratesestablished by a small employer carrier are assumed to be in effect but anyperiod of less than one year shall be considered as a full year.
(v) "Waiting period" means a period of time after full-time employment beginsbefore an employee is first eligible to enroll in any applicable health benefitplan offered by the small employer.
(w) "Small employer" means any person, firm, corporation, partnership orassociation eligible for group sickness and accident insurance pursuant tosubsection (a) of K.S.A. 40-2209 and amendments thereto actively engaged inbusiness whose total employed work force consisted of, on at least 50% of itsworking days during the preceding year, of at least two and no more than 50eligible employees, the majority of whom were employed within the state. Indetermining the number of eligible employees, companies which are affiliatedcompanies or which are eligible to file a combined tax return for purposes ofstate taxation, shall be considered one employer. Except asotherwise specifically provided, provisions of this act which apply to a smallemployer which has a health benefit plan shall continue to apply until the plananniversary following the date the employer no longer meets the requirements ofthis definition.
(x) "Affiliate" or "affiliated" means an entity or person who directly orindirectly through one or more intermediaries, controls or is controlled by, oris under common control with, a specified entity or person.
